Risk of endometrial cancer in asymptomatic postmenopausal patients with thickened endometrium: data from the FAME-Endo study: an observational register study

Hefler, Lukas; Lafleur, Judith; Kickmaier, Sonja; Leipold, Heinz; Siebenhofer, Carmen; Tringler, Barbara; Schauer, Christian; Ciresa-König, Alexandra; Reinthaller, Alexander

doi:10.1007/s00404-018-4885-3

Cited by 17 publications

(13 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While this finding was significant, the confidence interval was wide, reflecting uncertainty. Hefler et al determined the absolute risk of endometrial cancer in a woman without bleeding with endometrial thickness of ≥10 and ≥12 mm to be 5.2% and 6.7%, respectively 14 . However, why 5.2–6.7% is an acceptable absolute risk level for detecting endometrial cancer was not clearly justified.…”

Section: Resultsmentioning

confidence: 99%

“…Insufficient endometrial sampling occurred in 6.3% (57/900) in Hefler et al 14 risk of patients undergoing an invasive procedure without diagnostic yield. However, there were no insufficient samples reported by Li and Li, 16 Seckin et al, 20 Giannella et al 13 and Ozelci et al 18 Whether there were truly no insufficient samples or whether they were excluded from analyses was not specified.…”

Section: Insufficient Samplementioning

confidence: 98%

“…1). [10][11][12][13][14][15][16][17][18][19][20][21] The quality of evidence in each of these studies was evaluated.…”

Section: Pubmed Embase and The Cochrane Database Of Systematicmentioning

confidence: 99%

“…Seven studies reported diagnostic accuracy parameters of alternative endometrial thickness thresholds for endometrial cancer in asymptomatic postmenopausal women, as shown in Table 2. [14][15][16][17][18][19][20] Higher quality evidence from Li and Li identified 12 mm as the optimal threshold for differentiating benign lesions and endometrial cancer (AUC ROC 0.716, 95% CI 0.534-0.897, P = 0.019). 16 While this finding was significant, the confidence interval was wide, reflecting uncertainty.…”

Section: Alternative Thresholdsmentioning

confidence: 99%

See 3 more Smart Citations

Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

Chan

Johansson

2022

Aust NZ J Obst Gynaeco

View full text Add to dashboard Cite

Background Asymptomatic postmenopausal women incidentally found to have thickened endometrium (>4 mm) on transvaginal ultrasound (TVUS) often undergo hysteroscopy and dilatation and curettage despite having a low absolute risk of endometrial cancer. A low threshold for investigation may be unnecessary in these women. Aim This systematic literature review examines whether an increased TVUS endometrial thickness threshold has superior diagnostic accuracy for endometrial malignancies and premalignancies in asymptomatic postmenopausal women than the current threshold of ≥4 mm. Methods Pubmed, EMBASE and Cochrane Database of Systematic Reviews were systematically searched using keywords for publications between 2011 and 2021. Studies were included if they reported TVUS endometrial thickness analysis in asymptomatic postmenopausal women and excluded if they were written in a non‐English language. Quality of evidence in the included articles was evaluated according to recommendations by the Grading of Recommendations Assessment Development and Evaluation Working Group and reported results were tabulated. Results Of seven studies (N = 2986), better evidence identified 12 mm as the optimal diagnostic threshold (area under the curve receiver operating characteristic (AUC ROC) 0.716, 95% CI 0.534–0.897, P = 0.019) for endometrial cancer in asymptomatic postmenopausal women. Two higher quality studies (n = 488 and n = 4751) identified 11 mm as optimal for diagnosing both endometrial carcinoma and atypical hyperplasia (AUC ROC 0.587, 95% CI 0.465–0.708, P = 0.144 and 2.59 relative risk, 95% CI 1.66–4.05, P < 0.001). Conclusion Evidence for improved detection of endometrial premalignancies and malignancies using alternative endometrial thickness thresholds is not rigorous. Evidence for improved outcomes using alternative thresholds is inadequate. Observation of asymptomatic postmenopausal women without risk factors and with an endometrial thickness of less than 10 mm may be reasonable.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Insufficient Samplementioning

confidence: 98%

“…1). [10][11][12][13][14][15][16][17][18][19][20][21] The quality of evidence in each of these studies was evaluated.…”

Section: Pubmed Embase and The Cochrane Database Of Systematicmentioning

confidence: 99%

Section: Alternative Thresholdsmentioning

confidence: 99%

See 2 more Smart Citations

Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

Chan

Johansson

2022

Aust NZ J Obst Gynaeco

View full text Add to dashboard Cite

show abstract

“…However, this study had a smaller sample size and therefore did not account for individual risk factors. A larger prospective registered study included a total of 900 women with thickened endometrium 16 . This study reported the risk of atypical EH and EC to be 7.9% when using a cut‐off of 11 mm.…”

Section: Discussionmentioning

confidence: 99%

Determining a threshold measurement of endometrial thickness for asymptomatic postmenopausal women: A tertiary centre case series

Stewart

Gill

Readman

et al. 2022

Aust NZ J Obst Gynaeco

View full text Add to dashboard Cite

Background: An incidental finding of a thickened endometrium on ultrasound in the postmenopausal patient without bleeding is a common presentation to gynaecological services; however there is limited evidence to guide clinical practice as to when hysteroscopic evaluation and endometrial sampling is required. Aims:To determine the endometrial thickness at which endometrial sampling is indicated in asymptomatic postmenopausal women referred with thickened endometrium on ultrasound. Materials and Methods:A single-centre retrospective case series of postmenopausal women without bleeding undergoing hysteroscopy was conducted. Logistic regression was used to examine the association between a range of variables and pre-malignant or malignant pathology and endometrial thickness. The optimal endometrial thickness threshold was identified to maximise model sensitivity.Results: A total of 404 postmenopausal women were included in this study, having undergone a hysteroscopy at the study site between 1 July 2008 and 30 June 2018. The mean (SD) age of patients at presentation was 65 (9.09) years and the mean body mass index was 29.86 kg/m 2 (6.52). Of these women, nine (2.2%) were diagnosed with endometrial carcinoma and seven (1.7%) had endometrial hyperplasia with atypia. The most common histopathological finding was of a benign endometrial polyp (153: 37.9%). When including hyperplasia with or without atypia in histopathology of interest, a cut-off of ≥9 mm provides the greatest sensitivity (83.3%) and specificity (63.8%) for a diagnosis of pre-malignant or malignant pathology (classification accuracy of 64.8%; area under the receiver operating characteristic: 0.7358, 95% CI: 0.6439, 0.8278) in this cohort. Conclusions:Using an endometrial thickness of ≥9 mm can be used as a cut-off for endometrial sampling in postmenopausal women without bleeding.

show abstract

Estimating risk of endometrial malignancy and other intracavitary uterine pathology in women without abnormal uterine bleeding using IETA‐1 multinomial regression model: validation study

Heremans,

Wynants,

Valentin

et al. 2024

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

ObjectivesTo estimate the ability of the International Endometrial Tumor Analysis (IETA)‐1 polynomial regression model to estimate the risk of endometrial cancer and other intracavitary uterine pathology in women without abnormal uterine bleeding.MethodsThis is a retrospective study, in which we validated the IETA‐1 model on the IETA‐3 study cohort (n = 1745). IETA‐3 is a prospective observational multicenter study. It includes women without vaginal bleeding who underwent a standardized transvaginal ultrasound examination in seven ultrasound centers from 2011 until 2018. The ultrasonography was performed either as part of routine gynecological examination, follow‐up of non‐endometrial pathology, in the workup before fertility treatment, or before treatment for uterine prolapse or ovarian pathology. Ultrasonographic findings were described using IETA terminology and were compared with histology or with results of clinical and ultrasound follow‐up if endometrial sampling was not performed. The IETA‐1 model, which was created using data from patients with abnormal uterine bleeding, predicts four histological outcomes: 1) endometrial cancer (EC) or endometrial intraepithelial neoplasia (EIN), 2) endometrial polyp or intracavitary myoma, 3) hyperplasia without atypia, endometritis, or proliferative or secretory endometrium, and 4) endometrial atrophy. The predictors in the model are age, body mass index, and seven ultrasound variables (endometrial visibility, endometrial thickness, color score, cysts in the endometrium, non‐uniform echogenicity of the endometrium, presence of a bright edge, presence of a single dominant vessel). We analyzed the discriminative ability of the model (area under the receiver operating curve, AUC; polytomous discrimination index, PDI) and evaluated calibration of its risk estimates (observed/expected ratio, O/E).ResultsThe median age of the women in the IETA‐3 cohort was 51 years (range: 20 ‐ 85), and 51% (887/1745) of the women were postmenopausal. Histology showed EC or EIN in 29 (2%) women, endometrial polyps or intracavitary myomas in 1094 (63%), hyperplasia without atypia, endometritis, or proliferative or secretory endometrium in 144 (8%), and endometrial atrophy in 265 (15%) women. Insufficient material (n = 5, 0.3%) was classified as a separate benign outcome. For 208 (12%) women who did not undergo endometrial sampling but were followed up for at least 1 year without clinical or ultrasound signs of endometrial malignancy, the outcome was classified as benign. The IETA‐1 model had an AUC of 0.81 (95% CI: 0.73 ‐ 0.89, n = 1745) for discrimination between EC/EIN and benign endometrium, and the O/E for EC/EIN was 0.51 (95% CI: 0.32 ‐ 0.82). The AUC of the IETA‐1 model to discriminate between endometrial atrophy and all other intracavitary uterine conditions was 0.96 (95% CI: 0.95 ‐ 0.98). The PDI of the model was 0.68 (95% CI: 0.62 ‐ 0.73). Including only patients in whom the endometrium was measurable (n = 1689), the model's AUC was 0.83 (95%CI 0.75 ‐ 0.91) versus 0.62 (95% CI: 0.52 ‐ 0.73) when using endometrial thickness as the only predictor (difference in AUC 0.21, 95%CI: 0.08 ‐ 0.32). For postmenopausal women with measurable endometrial thickness (n = 848), the IETA‐1 model gave an AUC of 0.81 (95% CI: 0.71 ‐ 0.91) while the AUC for endometrial thickness was 0.70 (95% CI: 0.60 ‐ 0.81) (difference in AUC 0.11, 95%CI: 0.01 ‐ 0.20).ConclusionThe IETA‐1 model discriminated well between benign and malignant conditions in the uterine cavity in patients without abnormal bleeding, but it overestimated the risk of malignancy. It also discriminated well between the four outcome categories.This article is protected by copyright. All rights reserved.

show abstract

Risk of endometrial cancer in asymptomatic postmenopausal patients with thickened endometrium: data from the FAME-Endo study: an observational register study

Abstract: Our data compare favorably to a theoretical cohort suggesting a clinically reasonable cut-off of > 11 mm endometrial thickness to discriminate between "normal" and "pathological". The data regarding "risk for endometrial cancer" can be used for counseling affected women.

Cited by 17 publications

References 27 publications

Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

Can a higher endometrial thickness threshold exclude endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women? A systematic review

Determining a threshold measurement of endometrial thickness for asymptomatic postmenopausal women: A tertiary centre case series

Estimating risk of endometrial malignancy and other intracavitary uterine pathology in women without abnormal uterine bleeding using IETA‐1 multinomial regression model: validation study

Contact Info

Product

Resources

About